title: Pravastatin and cardiovascular outcomes stratified by baseline eGFR in the lipid- lowering component of ALLHAT.
abstract: OBJECTIVE
  The role of statins in preventing cardiovascular outcomes in patients with chronic kidney disease (CKD) is unclear. This paper compares cardiovascular outcomes with pravastatin vs. usual care, stratified by baseline estimated glomerular filtration rate (eGFR).
  
  
  METHODS
  Post-hoc analyses of a prospective randomized open-label clinical trial; 10,151 participants in the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (lipid-lowering component) were randomized to pravastatin 40 mg/day or usual care. Mean follow-up was 4.8 years.
  
  
  RESULTS
  Through Year 6, total cholesterol declined in pravastatin (-20.7%) and usualcare groups (-11.2%). Use of statin therapy in the pravastatin group was 89.8% (Year 2) and 87.0% (Year 6). Usual-care group statin use increased from 8.2% (Year 2) to 23.5% (Year 6). By primary intention-to-treat analyses, no significant differences were seen between groups for coronary heart disease (CHD), total mortality or combined cardiovascular disease; findings were consistent across eGFR strata. In exploratory "as-treated" analyses (patients actually using pravastatin vs. not using), pravastatin therapy was associated with lower mortality (HR = 0.76 (0.68 - 0.85), p<0.001) and lover CHD (HR=0.84 (0.73-0.97), p=0.01), but not combined cardiovascular disease (HR=0.95 (0.88-1.04), p=0.30). Total cholesterol reduction of 10 mg/dl from baseline to Year 2 was associated with 5% lower CHD risk.
  
  
  CONCLUSIONS
  In hypertensive patients with moderate dyslipidemia, pravastatin was not superior to usual care in preventing total mortality or CHD independent of baseline eGFR level. However, exploratory "as-treated" analyses suggest improved mortality and CHD risk in participants using pravastatin, and decreased CHD events associated with achieved reduction in total cholesterol. Potential benefit from statin therapy may depend on degree of reduction achieved in total and LDL-cholesterol and adherence to therapy.
authors.forename: Mahboob
authors.initials: M
authors.lastname: Rahman
authors.forename: Charles
authors.initials: C
authors.lastname: Baimbridge
authors.forename: Barry R
authors.initials: BR
authors.lastname: Davis
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Barzilay
authors.forename: Jan N
authors.initials: JN
authors.lastname: Basile
authors.forename: Mario A
authors.initials: MA
authors.lastname: Henriquez
authors.forename: Anne
authors.initials: A
authors.lastname: Huml
authors.forename: Nelson
authors.initials: N
authors.lastname: Kopyt
authors.forename: Gail T
authors.initials: GT
authors.lastname: Louis
authors.forename: Sara L
authors.initials: SL
authors.lastname: Pressel
authors.forename: Clive
authors.initials: C
authors.lastname: Rosendorff
authors.forename: Sithiporn
authors.initials: S
authors.lastname: Sastrasinh
authors.forename: Carol
authors.initials: C
authors.lastname: Stanford
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D008055:Lipids / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D017035:Pravastatin / Q000627:therapeutic use*; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008055:Lipids; D017035:Pravastatin